Inpatient & Outpatient Medications

Prophylactic use of antipyretics and sedatives/anticonvulsants for possible recurrence of febrile seizure has not shown to be effective.

Regular or sporadic administration of antipyretics during febrile illness is generally safe, but no study has shown them to be effective in reducing recurrence of febrile seizures.
[45, 46] Acetaminophen and ibuprofen are no better than placebo for preventing recurrences of febrile seizures .
[47]

Phenobarbital and valproic acid can be given daily and are effective, but they are associated with multiple adverse effects. Carbamazepine and phenytoin are not effective in preventing recurrent febrile seizures. Citing a preponderance of harm over benefit, the 2008 Clinical Practice Guideline for the Long-Term Management of the Child with Simple Febrile Seizures recommends neither continuous nor intermittent use of anticonvulsants for children with one or more simple febrile seizures.
[46]

Some studies report that diazepam, given orally or rectally every 8 hours during febrile illnesses, is effective in preventing recurrence of febrile seizures.
[48, 49] . However, these benzodiazepines can cause lethargy, drowsiness, and ataxia, and sedation could mask an evolving central nervous system infection. The AAP guideline released in 2008 does not recommend prophylactic use of diazepam as the risk outweighs the benefits.
[46]

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Deterrence/Prevention

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Given a more established role of influenza A in the etiology of febrile seizure, both acute and recurrent, vaccination against influenza A in the flu season may have a role in preventing development of both acute and recurrent febrile seizures.
[8]

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Prognosis

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Simple febrile seizures may slightly increase the risk of developing epilepsy,
[50] but they have no adverse effects on behavior, scholastic performance, or neurocognition. The risk of developing epilepsy is increased further in children with a history of complex febrile seizures.
[13, 51, 52, 53]

A strong association exists between febrile status epilepticus or febrile seizures characterized by focal symptoms and later development of temporal lobe epilepsy.
[50, 54]

Children with febrile seizures have a slightly higher incidence of epilepsy compared with the general population (2% vs 1%).

Risk factors for epilepsy later in life include complex febrile seizure, family history of epilepsy or neurologic abnormality, and developmental delay. Patients with 2 risk factors have up to a 10% chance of developing afebrile seizures.
[55]

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Patient Education

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Parents should be taught what to do if their child has another seizure.

The parent should be advised to call for assistance if the seizure lasts longer than 10 minutes or if the postictal period lasts longer than 30 minutes.

Parents should be counseled on the benign nature of febrile seizures.

Parents should be reassured that simple febrile seizures do not lead to neurologic problems or developmental delay.

Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. I--Prevalence and recurrence in the first five years of life. Br Med J (Clin Res Ed). 1985 May 4. 290(6478):1307-10. [Medline].

Verity CM, Butler NR, Golding J. Febrile convulsions in a national cohort followed up from birth. II--Medical history and intellectual ability at 5 years of age. Br Med J (Clin Res Ed). 1985 May 4. 290(6478):1311-5. [Medline].

Debra Slapper, MD Physician, Southwest Washington Free Clinic System-Urgent Care; Former FEMA Physician and Military Contractor; Former Associate Professor, University of Miami, Leonard M Miller School of Medicine and University of South Florida Morsani College of Medicine